DSM: Bipolar and related Disorders

Question 1

Mania

Answer 1

Manic episode:
A. A distinct period of elevated, expansive or irritable mood and abnormal and persistently increased energy for > 1 week nearly daily (or less if hospitalized)
B. During that period, 3 or more of the following are noted and represent a significant change in behaviour:
1. grandiosity/inflated self-esteem
2. decreased need for sleep
3. increased/pressured talking
4. flight of ideas or subjective racing thoughts
5. distractible
6. increased goal directed activity (socially, work/school, sexually) or psychomotor agitation
7. risky activities– potential painful consequences
C. Mood disturbance is severe enough to cause marked impairment in social or occupational function or require hospitalization to prevent harm to self/others, or psychotic features/
D. Not due to physiological effects of substance (medication or drug) or another medical condition.

Question 2

Hypomania

Answer 2

A. Distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently elevated energy/activity, lasting 4 days
B. During this period: 3 or more (4 if mood is irritable) are present and are a change from usual:
1. inflated self-esteem/grandiosity
2. decreased need for sleep
3. more or pressured speech
4. flight of ideas or subjective racing thoughts
5. distractible
6. increased goal directed activity (social, work/school, sex) or psychomotor agitation
7. excessive involvement in risk taking behaviours with potentially painful consequences
C. Symptoms present unequivocal change in functioning that is uncharacteristic when pt is not symptomatic
D. Disturbance in mood and change in function is observable by others.
E. Not severe enough to sue mark impairment in social or occupational function, or to require hospitalization. No psychotic features.
F. Not attributable to physiological effects of substances or another medical condition

Question 3

Bipolar disorder 1

Answer 3

A. Criteria have been met for at least 1 manic episode
B. occurrence of mania and MDEs is not better explained by schizoaffective d/o, schizophrenia, schizophreniform d/o, delusional d/o, or other specified/unspecified psychotic disorder

Question 4

Bipolar disorder specifiers

Answer 4

current or most recent episode manic
current/most recent episode hypomanic
current or most recent episode depressed
current or most recent episode unspecified
with psychotic features
in partial remission
in full remission
with anxious distress
with mixed features
with rapid cycling
with melancholic features
with atypical features
with mood -congruent psychotic features
with mood incongruent psychotic features
with catatonia
with permpartum onset
with seasonal pattern

Question 5

Bipolar II disorder

Answer 5

A. Criteria have been met for at least 1 hypomanic episode and at least 1 MDE
B. There has never been a manic episode
C. The occurrence of the hypomanic and MDEs are not better explained by schizoaffective, schizophrenia, schizophreniform, delusional d/o or other/unspecified schizophrenia d/0
D. Clinically significant distress or impairment in social, occupational, or other areas of function.

Question 6

Bipolar II disorder specifiers

Answer 6

• hypomanic or depressed
• features: anxious distress, mixed features, rapid cycling, melancholic features, atypical features, mood congruent psychotic features, mood-incongruent psychotic features, catatonia, permpartum onset, seasonal pattern
• in partial remission or full remission
• severity: mild, moderate, severe

Question 7

Cyclothymic disorder

Answer 7

A. 2 year (1 year in Children & Adolescents) of numerous periods with hypomanic symptoms that do not meet full criteria and numerous periods with depressive sx that do not meet full criteria for MDE
B. During the 2 years (1 yr in CAP), they hypomanic and depressive periods have been present at least half the time and the individual has not been w/o sx for more than 2/12
C. Criteria for MDE, manic or hypomanic episodes have never been met.
D. Not a psychotic disorder
E. Not due to physiologic effects of a substance (eg drug of abuse or medication) or another medical condition (eg hyperthyroid)
F. Clinically significant distress or impairment in social, occupational or other function

Question 8

Cyclothymic disorder specifiers

Answer 8

with anxious distress

Question 9

Substance/Medication Induced Bipolar and Related D/0

Answer 9

A. Prominent and persistent disturbance in mood that is elevated, expansive air irritable mood, with or w/o depressed mood, or markedly diminished interest/pleasure in activities
B. Evidence on hx/phyiscal exam/labs of:
1. Sx of A. developed during/after substance intoxication/withdrawal/exposure
2. susbstance/medication is capable of producing sx
C. Disturbance not better explained by bipolar d/o– esp if sx precede onset of substance/medication use or persist for a substantial period (>1 month) after end of acute withdrawal/intoxication or there is other evidence suggesting primary d/o
D. Not during delirium
E. Clinically significant distress or impairment

Question 10

Substance/medication induced bipolar and related d/o

Answer 10

specify substance: alcohol, phenylcylidine, other hallucinogen, sedative, hypnotic or anxiolytic, amphetamine (or other stimulant), cocaines, other/unknown
specify: with use d/o mild, moderate/severe, or without use disorder
specify with onset during intoxication or withdrawal

Question 11

Bipolar and related d/o due to another medical condition

Answer 11

A. Prominent and persistently abnormally elevated, expansive or irritable mood and abnormally increased activity or energy that predominates the clinical picture
B. Evidence from hx/physical exam/labs that disturbance is directly related to pathyphysiology of another medical condition
C. Not better explained by another mental d/o
D. Not exclusively during delerium
E. Clinically significant distress/impariement or necessitates hospitalization to prevent harm to self/others, or there are psychotic features
specify: manic features (full criteria not met), with manic or hypomanic-like episode (full crieteria met except for not due to another medical condition), or mixed features
typically: hyperthyroidism, Cushing syndrome, MS, stroke, TBI

Question 12

Other specified bipolar and related d/o

Answer 12

• presentations causing distress/impairment but not meeting full criteria– examples incl
  1. Short duration hypomanic episodes (2-3 days) and MDE
  2. Hypomanic episodes with insufficient sx and MDEs
  3. Hypomanic episode without prior MDE
  4. short duration cyclothymia (< 24 months)